<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609924
Report Date: 08/08/2023
Date Signed: 08/08/2023 11:45:10 AM

Document Has Been Signed on 08/08/2023 11:45 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:DIVINE FUTURES IVFACILITY NUMBER:
197609924
ADMINISTRATOR:VASHAN BOBNEYFACILITY TYPE:
735
ADDRESS:3525 E GARNET LANETELEPHONE:
(818) 270-6434
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 4DATE:
08/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vashan BobneyTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Evelin Rios made an unannounced case management visit to this facility. LPA Rios met with administrator Vashan Bobney and explained the reason for the visit. Administrator contacted Licensee Anthony Powell and LPA informed licensee, licensing fees are past due in the amount of $2043.00 at this time. LPA and administrator conducted a physical plant tour of the facility, no health and safety issues were observed.

During today's visit, LPA provided "PIN" number to pay annual fees online to licensee. LPA provided a copy of a letter stating the annual fees are outstanding and the balance due must be paid in full by 8/09/23. Failure to pay the amount in full by 8/09/23 is subject to forfeiture of license. According to licensee facility has had an issue with receiving notifications about annual fees due. Licensee paid over due balance fee during today's visit.

No deficiencies cited. Exit interview conducted and a copy of this report issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1